Scaffold for spring ligament repair

ABSTRACT

A construct is disclosed that may be used to repair or replace a natural ligament. The construct may be formed of materials for biocompatibility and/or resorbtion. The construct may be provided or connected to a soft anchor for connection to a bone portion.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.61/783,976, filed on Mar. 14, 2013.

This application is a continuation-in-part of U.S. patent applicationSer. No. 14/055,191 filed on Oct. 16, 2013, which is a divisional ofU.S. patent application Ser. No. 13/098,897 filed on May 2, 2011, nowU.S. Pat. No. 8,562,645 issued on Oct. 22, 2013, which is acontinuation-in-part of U.S. patent application Ser. No. 12/702,067filed on Feb. 8, 2010, which is a continuation of U.S. patentapplication Ser. No. 11/541,505 filed on Sep. 29, 2006 and is now U.S.Pat. No. 7,658,751 issued on Feb. 9, 2010.

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/719,337 filed on Mar. 8, 2010, which is acontinuation-in-part of U.S. patent application Ser. No. 12/489,168filed on Jun. 22, 2009, now U.S. Pat. No. 8,361,113 issued on Jan. 29,2013, which is a continuation-in-part of U.S. patent application Ser.No. 12/474,802 filed on May 29, 2009, now U.S. Pat. No. 8,088,130 issuedon Jan. 3, 2012, which is a continuation-in-part of (a) U.S. patentapplication Ser. No. 12/196,405 filed on Aug. 22, 2008, now U.S. Pat.No. 8,128,658 issued on Mar. 6, 2012; (b) U.S. patent application Ser.No. 12/196,407 filed on Aug. 22, 2008, now U.S. Pat. No. 8,137,382issued on Mar. 20, 2012; (c) U.S. patent application Ser. No. 12/196,410filed on Aug. 22, 2008, now U.S. Pat. No. 8,118,836 issued on Feb. 21,2012; and (d) U.S. patent application Ser. No. 11/541,506 filed on Sep.29, 2006, now U.S. Pat. No. 7,601,165 issued on Oct. 13, 2009.

The entire disclosure of the above applications are incorporated hereinby reference.

FIELD

The subject disclosure is generally directed towards ligament repairand/or augmentation, and particularly to an augment construct that isconfigured to replace or augment a spring ligament in a foot.

BACKGROUND

This section provides background information related to the presentdisclosure which is not necessarily prior art.

A spring ligament is an anatomical ligament that interconnects variousportions of a foot. Generally, the spring ligament may interconnect atleast a navicular and a calcaneus. Various branches of the springligament, however, may also extend to connect or interconnect thecalcaneus with the first cuneiform.

Injury to the spring ligament may lead to various issues, such asflat-foot deformities. Injuries to the spring ligament may not generallybe diagnosed or repaired until various auxiliary issues presentthemselves, such as flat-foot deformities. Repairing a defect in thespring ligament, therefore, may lead to prevention of variousafflictions.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

A ligament construct may be manufactured to repair or replace a selectedligament. For example, a spring ligament replacement or augment mayinclude a synthetic scaffold that may be formed or manufactured togenerally replace the spring ligament. The synthetic scaffold may beformed of polyester, polyethylene, resorbable materials, or combinationsthereof. The synthetic scaffold may be formed of a woven or braidedpolyester or polyethylene material that is formed into selectedconfiguration or shape to replace the spring ligament.

Selected suture anchoring systems and tensioning systems may be used tofixedly connect the ligament augment to the anatomy. For example, aJuggerknot™ soft anchor or suture anchor may be used to provide ananchor adjacent to or inside of a bone member. Alternatively, aToggleLoc™ hard suture anchor may be used. A suture tensioning system,such as the Ziploop™ suture tensioning system may be used to draw thescaffold into the bone, and tension the augment relative to the bonewhile the Juggerknot™ anchor system is used to anchor the construct. Itis understood, however, that the tensioning system may be used incombination with any appropriate anchor, such as an interference screwor other bone anchor system.

The scaffold may be used to replace the spring ligament. For example, auser may identify a spring ligament tear or removal from a bone portionand identify a need for an augment or ligament replacement. The springligament construct may then be fixed relative to the bone, such as withan appropriate anchor and tensioning system. The anchors may include theJuggerknot™ soft anchor system. The construct may then be maintainedrelative to the bone for a procedure and/or fixed to the remainingportion of the spring ligament to assist in augmenting the remainingspring ligament portions.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1A is a top plan view of a ligament construct connected to suture,according to various embodiments;

FIG. 1B is a side plan view of the ligament construct of FIG. 1Aconnected to suture;

FIG. 2A is a top plan view of a ligament construct according to variousembodiments;

FIG. 2B is a side plan view of the ligament construct of FIG. 2Aconnected to suture;

FIG. 3 is a top plan view of a ligament construct according to variousembodiments;

FIG. 4 is a detail view of a portion of a ligament construct connectedto a suture and an anchor, according to various embodiments;

FIG. 5 is a side plan view of bones of a human foot illustrating apartial implantation of a ligament construct in a navicular bone;

FIG. 6 is a side plan view of bones of a human foot illustrating apartial implantation of a ligament construct in a navicular bone andcalcaneus bone;

FIG. 7A is a side plan view of bones of a human foot illustrating animplantation and tensioning of a ligament construct in a navicular boneand calcaneus bone;

FIG. 7B is a bottom plan view of bones of a human foot illustrating animplantation and tensioning of a ligament construct in a navicular boneand calcaneus bone;

FIG. 8 is a side plan view of bones of a human foot illustrating animplantation and tensioning of a ligament construct in a cuneiform, anavicular bone, and a calcaneus bone, according to various embodiments;

FIG. 9 is a top plan view of a ligament construct connected to a suture,according to various embodiments; and

FIG. 10 is a side plan view of bones of a human foot illustrating animplantation and tensioning of a ligament construct in a navicular bone,talus bone, and calcaneus bone, according to various embodiments.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings.

With reference to FIGS. 1A and 1B, a ligament augment or replacementconstruct 20 is illustrated. The ligament construct 20 may be formed ofselected materials, such as a woven or braided polyester or polyethylenematerial. Additionally, various absorbable materials may be included orused to form the construct 20, such as polylactic acid or other selectedmaterials. The construct 20 may be formed of a woven material and/orformed of a solid material of a selected type. The construct 20,according to various embodiments, may be resilient with little to noelasticity. Thus, the length of the construct 20 may be selected andmaintained during implantation. Also, the construct 20, therefore, maybe tensioned and maintain a tension after implantation.

The construct 20 may include a selected length 22 that extends between afirst end 24 and a second end 26. The two ends 24, 26 may be formed byfolding terminal end regions 28 and 30 over and towards a center of theconstruct 20. The terminal ends 28, 30 may be folded onto a body portion36 of the construct 20. The terminal ends 28, 30 may be stitched,sonically welded, or otherwise fixed with a mechanism 32, 34 to the mainbody portion 36 of the construct. The folding over of the terminal ends28, 30 may form passages, also referred to as eyelets, a loop, or openregions 40 and 42 near the ends 24, 26 of the construct 20. Thepassages, as discussed herein, may be engaged or coupled to suturesand/or anchor members.

The main body portion, or selected portions of the construct 20, mayhave a thickness 44 based upon various characteristics of the construct20, such as strength, rigidity, elasticity, and the like. Moreover, itis understood that if the construct 20 is formed of a braided, woven, orother appropriate material that the thickness 44 may decrease under aload between the two eyelet portions 40, 42. The thickness 44, however,may be defined by one or more strands of a woven material

According to various embodiments, the eyelets 40, 42 may be formedaround suture and one or more suture constructs including a first sutureconstruct 50 and a second suture construct 52; and; or the sutureconstructs 50, 52 may be formed within the eyelets 40, 42 and around theconstruct 20. The suture constructs 50 and 52 may be separate, butsubstantially identical and interconnected with the separate eyelets 40,42 for fixation of the construct 20 relative to a selected anatomy, asdiscussed further herein. The suture constructs 50, 52 may be similar tothe suture constructs disclosed in U.S. Pat. No. 8,118,836, issued Feb.21, 2012; U.S. Pat. App. Pub. No. 2011/0098727, published on Apr. 28,2011; or U.S. Pat. App. Pub. No. 2012/0095470, published on Apr. 19,2012; all incorporated herein by reference.

Generally, the suture constructs may include respective anchors that maybe formed as tubes 54, 56 through which a suture or selected filament58, 60 passes. The suture 58, 60, when acted upon by a user, may causethe tubes 54, 56 to form an anchoring mass as knots or soft anchors tohold the construct 20 in a selected position. The anchoring mass can beformed on an exterior surface of a bone or formed within a bone surface,as discussed further herein. The suture anchors may include the Ziploop™constructs to allow for slip tensioning of a portion positioned relativeto the Ziploop suture construct and a Juggerknot™ anchor portion thatmay be formed by the respective tubes 54, 56. Each of the Ziploop™suture construct and the Juggerknot™ soft anchor portion are sold byBiomet, Inc.

The sutures 58, 60 may further pass through a body or passage portion70, 72 where two suture ends of each suture construct 50, 52 extend fromthe respective passage portions 70, 72. Each of the sutures 50, 52 hasthe respective passage portion 70, 72 and each defines a respectivethrough-passage through the passage portions 70, 72. Each sutureconstruct 50, 52 further has two ends 76, 78 and 80, 82. For each sutureconstruct the first end 76, 80 is passed into the through-passagethrough a first aperture to form a first loop and exits thethrough-passage through a second aperture and the second end 78, 82 ispassed into the through-passage through a third aperture to form asecond loop and exits the through-passage through a fourth aperture. Itis understood, according to various embodiments, the first and thirdaperture may be the same aperture as may the second and fourth aperture.Thus, each passage portion may include 2, 3, or 4, or a selected numberof apertures into the through-passage of the passage portion. Each ofthe two suture ends 76, 78 and 80, 82 may be acted upon by a user tocollapse the respective anchors 50, 56 to form the soft anchoring massesand tension the construct 20 between two points of the anchors 54 and56, as discussed further herein.

The anchor assemblies 50, 52 including the anchors 54, 56, also referredto as tubes, which may generally include a collapsible tube that is aclosed loop of suture material that is formed into the tube shape.According to various embodiments, the tube assembly 54, 56 may beslideable relative to the suture loops or filaments 58, 60. Briefly,although disclosed in the U.S. Pat. No. 8,118,836, incorporated hereinby reference, the suture assemblies 50, 52 may include the sutureportions 58, 60 that pass through openings 55, 57 of the respectivetubes 54, 56. Alternatively, the suture portions may pass out anaperture that is not at the openings 55, 57 such that one or both endsof the tubes 54, 56 form flaccid or unbound ends.

Generally, the suture portions 58, 60 may be single or continuous suturefilaments that extend through the respective tubes, 50, 56 in therespective braided bodies 70, 72 of the suture assemblies 50, 52. Thesuture assemblies 50, 52, therefore, may be manipulated by a user togenerate a soft anchor, as discussed herein, by collapsing therespective tubes 50, 56, and tensioning the construct 20 relative toselected areas of a subject by moving the ends 76-82 to tension theconstruct 20 relative to the respective anchors formed by the tubes 54,56. The anchors 54, 56 collapse under a force, such as a tensile force,provided by or through the respective suture portions 58, 60 to formsoft or anchor masses in respective areas, as discussed further herein.The tubes 54, 56 may form the anchors by collapsing the tubes 54, 56relative to a positive or adjacent surface of the tube 54, 56.

With reference to FIGS. 2A and 2B, a construct 100 is illustrated. Theconstruct 100 may be similar to the construct 20 in generalconstruction. For example, the construct 100 may be formed of a wovenselected material, such as polyester or polyethylene. Additionally, theconstruct 100 may be formed from a selected material includingbio-absorbable materials that may be absorbed into a selected anatomyover time and allow for ingrowth of various tissues to replace portionsof the construct 100.

The construct 100, however, may also be formed in a substantiallyelongated and rectangular construct including a length 102 from a firstend 100 a to a second end 100 b of about 4 centimeters (cm) to about 10cm, and further including 4 cm to about 8 cm. Additionally, theconstruct 100 may include a width 104 that is about 0.5 cm to about 4cm, including about 1-3 cm, and further including about 1 cm to about 2cm. The construct 100, as illustrated in FIG. 2B, may further include athickness 106 that is about 0.5 millimeters (mm) to about 4 mm, andfurther including about 1 mm to about 3 mm.

The construct 100 may include one or more bores 110 formed from a firstside to a second side through the thickness 106 of the construct 100.The bores 110 may be formed in a selected configuration, such as near aperimeter of the construct 100. The bores 110 are generally formed at ornear both of the ends 100 a, 100 b of the construct 100. Thus, the ends100 a, 100 b of the construct 100 can be engaged and tensioned relativeto selected anchoring regions, as discussed herein. The bores 110 mayallow for passage of selected anchor assemblies, such as an anchorassembly 120, as discussed further herein. Any appropriate anchoringassembly, such as the construct 50, however, may also be used.

The anchor assembly 120 may pass through one or more of the throughbores110 to allow for fixation of the construct 100 relative to a selectedsubject. The bores 110 may be throughbores formed through the construct100 through various techniques such as puncturing, drilling, ultrasonicwelding or puncturing, or other appropriate mechanisms. Also, thethrough bores 110 may be formed between braided or woven fibers of theconstruct 100. Regardless, the bores 110 may be throughbores formedthrough the entire thickness 106 of a construct 100 to allow for passageof anchor assemblies 120.

The anchor assembly 120 may be an anchor assembly including an anchorassembly as disclosed in U.S. Pat. No. 8,118,836, incorporated herein byreference. The anchor assembly 120 may include various portions similarto the anchor assemblies 50, 52 described above. Generally, the anchorassembly 120 may include a first collapsible anchor 122 (also referredto as a tube) and a second collapsible anchor 124 (also referred to as atube) which are disposed about or around respective suture loops 126 and128 that are a part of a single elongated suture of the anchor assembly120. As tension is applied on the respective suture loops 126, 128, theanchors 122, 124 collapse and may form anchoring masses relative toselected portions of a subject, similar to the anchors 54, 56 discussedabove. It is understood that the respective suture anchors 122, 124 maybe collapsed simultaneously and/or at staggered times, as selectedand/or desired by a user.

The suture loops 126, 128 are portions of a suture 130 that furtherinclude suture ends 132 and 134. The suture ends may be gasped ormanipulated by a user to collapse the tubes 122, 124 to form the softanchors. Additionally, the suture 130 may be passed through a passageportion 140 having a through-passage as discussed above and as disclosedin U.S. Pat. No. 8,118,836, incorporated herein by reference. The sutureends 132, 134 may be manipulated to move the passage portion 140relative to the tubes 122, 124. As discussed above, the movement of thepassage portion 140 relative to the tubes 122, 124 may tension theconstruct 100 relative to the tubes 122, 124 when the tubes arecollapsed against a respective positive surface, such as a bone surface.Accordingly, the construct 100 may be tensioned relative to a bonesurface as discussed further herein by pulling on the ends 132, 134 ofthe suture loop 130.

With reference to FIG. 3, a construct 170, according to variousembodiments, is illustrated. The construct 170 may include variousdimensions, such as a length 172 that may be about 3 cm to about 10 cm,including about 4 cm to about 8 cm. The construct 170 may furtherinclude a height 174 that includes a selected height of about 1 cm toabout 4 cm, including about 2-3 cm. The height 174 may include a heightor a length of arm portions 176 and 178 that extend from a main bodyportion 180 of the construct 170. The main body portion 180, however,may include an end 182 that may include a height 184 having a dimensionof about 0.5 cm to about 2 cm, and further including a height of about 1cm.

The construct 170 may be similar in construction to the constructs 20and 100, as discussed above. Accordingly, the construct 170 can includeany selected portion to interconnect with a suture and/or anchorassembly. For example, an eyelet can be formed near the terminal ends ofthe construct and/or throughbores may be formed through the construct170. For example, a suture construct 52 a that includes an anchor 56 acan be coupled to an eyelet formed by folding over a terminal end andfixing it with a fixing structure 183 near the first end 182. The sutureconstruct can be similar or identical to the suture construct 52. It isunderstood that each arm 176, 178 can include a fold formed eyelet andone or more throughbores and individual coupled suture constructs,according to various embodiments.

The construct 170, however, may include the single end 182 and the twoarms 176 and 178 extending from an area at the second end of theconstruct 170. As discussed herein, the first end 182 may engage a firstbone member or portion while the two arms 176 and 178 may engageseparate bone members or constructs as discussed herein. Thus, at eacharm 176, 178 and the first end 182 a suture construct including ananchor portion can be connected. Fixation of the construct 172 toselected bone portions may include various suture anchors and assemblies50, 52 and 120 as discussed above. Accordingly, the construct 170 may befixed relative to a selected portion of a subject similar to thefixation or anchoring mechanisms as discussed above.

With reference to FIGS. 1A-1B, discussed above, and additional referenceto FIG. 4, the construct 20, or construct according to variousembodiments as discussed above, may be engaged or associated with ananchor assembly 190. The anchor assembly 190 may include a fixationmember 192, such as a Toggleloc™ anchor, sold by Biomet, Inc., that isrigid. The rigid fixation member 192 may include that illustrated anddisclosed in U.S. Patent Application Publication No. 2012/0116452 andU.S. Pat. No. 7,695,503, both incorporated herein by reference. Inaddition, the anchor 192 may be interconnected or associated with asuture assembly 202, similar to the suture assemblies 50, 52 discussedabove. The suture assembly 202 may include a passage portion 204 towhich a continuous suture 206 is passed. The continuous suture 206 mayinclude a continuous loop of suture that passes through the passageportion 204. The passage portion 204 may be formed through the anchor192, as illustrated in FIG. 4.

The construct 20 may also be formed around the filament or loop portionsof the suture portion 208 to engage the construct 20 relative to theanchor 192. The construct 20 may have the eyelet 42 formed by suturingor interconnecting an end 30 of the construct 20 with a suture portion34. The construct 20, therefore, may be held relative to the anchor 192with the suture assembly 202. Generally, the anchor 192 may include anelongated arm portion 220 and an eyelet or interconnection portion 222to engage the suture assembly 202.

Accordingly, it is understood that the construct, according to variousembodiments including the construct 20, the construct 100, and theconstruct 170, may be interconnected with a selected anchor orconnecting portion. The connecting portion may include soft anchors,such as those illustrated with the suture assembly 50 or the sutureanchor assembly 120. Additionally, a hard or rigid fixation member mayinclude the fixation member 192 illustrated in FIG. 4.

The ligament construct, according to various embodiments as discussedabove, may be provided relative to a selected portion of a subject, suchas a foot 300 of a subject, illustrated in FIG. 5. The foot 300 of thesubject may include various anatomical bone portions, such as thosegenerally known in the art. For example, the foot 300 may includephalange members 302, metatarsal members 304, a medial (first tarsal)cuneiform 306, a navicular 308, a talus 310, and a calcaneus 312. Thefoot 300 may be connected or articulated with other boney portions, suchas a tibia and a fibula, as is generally understood in the art.

With additional reference to FIG. 5, the various boney portions of thefoot 300 may be interconnected with a construct, including the variousembodiments of a construct as discussed above. For exemplary purposes,the construct 20 is illustrated and discussed. It is understood,however, that the construct 100 may be used relative to the foot 300including the suture assembly 50, 52 and/or the anchor suture assembly120, as discussed above. Nevertheless, for illustration of a selectedprocedure to replace a spring ligament or augment a spring ligament in afoot 300, the construct 20 is discussed further herein.

As illustrated in FIG. 5, the navicular 308 may be configured to includea throughbore 320 through which the anchor 54 may be passed andcollapsed upon an exterior bone surface of the navicular 308 to form theanchoring mass or portion 54′, such as a soft anchor, relative to thenavicular bone 308. The anchor portion 54′ may be defined as a large oranchoring mass formed near the bone surface. A locking profile of thetube 54 may allow the anchoring mass to be formed by the application ofa tensile force with the suture 58. The bore 320 may be formed to allowfor passage and receipt of at least a portion of the construct 20 into aportion of the bore 320. The drawing or tensioning of the construct 20into the bore 320 may be performed with the suture assembly 52 bydrawing or tensioning the suture ends 76, 78 and drawing the construct20 into the bore 320. The formation of the bore 320 and tensioning ofthe construct 20 into the bore 320 will be discussed further in relationto the calcaneus 312 in a bore 340 formed therein, discussed furtherherein.

With a continuing reference to FIG. 5, the calcaneus 312 may have a bore340 formed therein including a plurality of diameters. For example, afirst or small drill/pin 342 may be passed through or drilled throughthe calcaneus 312 to form a small bore or first bore passage 344. Asecond or larger drill bit 349 (the larger drill bit 349 may becannulated) may be passed over the small bit 342 to form a second orlarger bore 352. Accordingly, the bore 340 formed through the calcaneus312 may include a first diameter bore 344 and a second diameter bore352. The bore 320 formed in the navicular 308 may include a similarlarge diameter bore portion and a small diameter bore portion. The largediameter bore portion may receive a portion of the construct 20 whilethe small diameter bore portion may allow for passage of the sutureconstruct 50, 52 to allow for movement of the respective tubes 54, 56 toa second portion of the respective bone to form the soft anchor relativethereto. Moreover, a shoulder or ledge 320 a, 340 a is formed within therespective bores 320, 340 due to the different diameters.

With reference to FIG. 6, the anchor assembly, including the sutureanchor assembly 52 that is connected to an end of the construct 20, maybe passed through the bore 340 formed to the calcaneus 312, or selectedbone portion. The suture assembly 52 and/or only the anchor 56 alone maybe passed through the bore 340. An appropriate passing member mayinterconnect with the anchor 56 and/or the suture ends 80, 82 to push orpull the suture assembly through the bore 340 formed to the calcaneus312. The construct 20 interconnected with the suture anchor assembly 52,however, may be moved relative to the calcaneus 312 to allow for passageof the suture anchor assembly 52 through the bore 340 formed through thecalcaneus 312.

As illustrated in FIG. 6, the construct 20 may be pulled into the bore320 formed in the navicular 308 and the anchoring portion 54′ may beformed relative to the navicular 308 by tensioning the anchor 54relative to the navicular 308, as is generally understood in the art.The suture assembly 52 may then be moved through the bore 340 formedthrough the calcaneus 312, as illustrated in FIG. 6. It is understood,however, that the suture assembly 52 may be first passed through thecalcaneus 312 prior to passage of the suture assembly 50 through thenavicular 308. The order of placing the anchors relative to individualbone portions is exemplary, and not intended to be limiting. Afterforming the bore 340 through the calcaneus 312, the suture assembly 52may be passed through the calcaneus 312. According to variousembodiments, the anchors, including the soft anchors, can be formed onthe surface of the bone portions at all selected anchoring points. Theneach end of the construct can be alternatingly tightened tosubstantially ensure uniform tensioning of the construct 20.

The passage of the suture assembly 52 through the calcaneus 312 maygenerally be in the direction of arrow 313. The passage of the sutureassembly 52 may be according to appropriate mechanisms, such as pullingthe suture assembly 52 through the bore 340 or pushing the sutureassembly 52 through the bore 340. Generally, however, the anchor 56 maybe passed through a distal cortical bone portion 391 a, as illustratedin FIG. 7A, and a second cortical bone portion 391 b, is alsoillustrated in FIG. 7A. The bore 340 may further be formed through bothof the cortical bone portions 391 a and 391 b and further through thecancellous bone portion 389, therebetween.

Accordingly, a soft anchor may be formed by the anchor 56 on an exteriordistal surface of the cortical bone portion of the calcaneus 312. Theanchor 56 may be formed by drawing the construct 20 into the large boreportion 352, by manipulating the ends of the suture filaments 80, 82, toform the soft anchor 56′. The construct 20 may then be tensioned anddrawn into the bore 340.

With continuing reference FIGS. 5 and 6, and additional reference toFIGS. 7A and 7B, the construct 20 may be tensioned into the bore 320formed within the navicular 308 and the bore 340 formed in the calcaneus312. The bore 320 in the navicular 308 may include a large bore portion320 a and a small bore portion 320 b similar to the large bore 352 andthe small bore portion 344 formed through the calcaneus 312. The largebore portion, of both the navicular 308 and the calcaneus 312, mayinclude a diameter 352 a such as about 4 mm to about 6 mm. The smallbore portion of both the calcaneus 312 and the navicular 308 may includea diameter 344 a of about 2 mm to about 4 mm. It is understood, however,that the bore formed through the respective bone portions may be anyappropriate diameter to receive the constructs positioned within therespective bore portions and interact with the anchor members positionedrelative to the bone portions.

The anchor portion 54′ formed by the tube 54 and anchor portion 56′formed by the tube 56 may be formed on an exterior surface of the boneportions 308, 312 such as on an exterior surface of the cortical bonethereof. The anchor portions 54′, 56′ can fix or anchor the construct 20relative to the bone portions. The anchor portions 54′, 56′ may bedefined as a large or anchoring mass formed near the bone surface. Alocking profile of the tubes 54, 56 may allow the anchoring mass to beformed by the application of a tensile force with the suture 58, 60. Theconstruct 20 may then be tensioned relative to the anchor portions 54′,56′ to form a selectively tensioned construct 20 relative to the twobones of the navicular 308 and the calcaneus 312 to augment or replacethe spring ligament.

The soft anchors 54′, 56′ however, may be formed within the respectivebone portions 308 and 312 relative to a cancellous bone portions 389 and367 to engage the proximal cortical bone portions 391 b and 369 of therespective bone members 308 and 312. Accordingly, the soft anchorportions 54′, 56′ need not be formed on the exterior surface of therespective bone member 308 and 312 to anchor the construct 20 relativeto the respective bone portions 308 and 312. Rather, the bone anchors orconstruct anchors may be formed within the bone surfaces to provide forfixation of the construct 20 relative to the respective bone members 308and 312. Formation of an anchor assembly within the bone member may beformed as discussed above and with an anchor assembly as disclosed inU.S. Patent Application 2011/0098727, published Apr. 28, 2011,incorporated herein by reference. The formation of the soft anchor 54′,56′ may be substantially similar, save that the soft anchor is formedwithin the tunnel 340 and 320 of the respective bone members.

The construct 20 may be positioned relative to respective bone portions,such as the calcaneus 312 and navicular 308, as discussed above andillustrated in various figures, including FIGS. 6-7B. The construct 100may be similarly positioned between two selected bone portions, such asthe calcaneus 312 and navicular 308. According to various embodiments,the construct 170 may be interconnected with two or more bones portionsof the foot 300, as illustrated in FIG. 8. The construct 170, includingthe main body portion 180, the arm member 178, and the arm member 176may be connected or positioned relative to the navicular 308 and thefirst cuneiform 306. Additionally, the end of 182 of the main body 180may be positioned relative to the calcaneus 312 of the foot 300.

The fixation of the construct 170 relative to the respective boneportions may be with the suture anchor construct, such as the sutureanchor construct 52. Accordingly, each of the ends of the construct 170may be coupled to bone portions with a suture anchor such as the sutureanchor at 56 a relative to the first cuneiform, a suture anchor 56 brelative to the navicular 308, and a suture anchor 56 c relative to thecalcaneus 312. It is understood, however, that the various anchor offixation members may be positioned relative to the respective boneymembers, including the first cuneiform 306, navicular 308, and thecalcaneus 312, to fix the construct 170 relative thereto. For example,the suture anchor assembly 120 may be interconnected with the construct170 to anchor relative to the selected bone portions in addition to theanchor fixation member 190, as illustrated in FIG. 4.

Accordingly, a ligament construct may be provided to augment and/orreplace the spring ligament. The ligament construct, therefore, caninterconnect various portions of the foot 300, including the calcaneus312 and the navicular 308. In various embodiments, the first cuneiform306 may also be interconnected relative to the navicular 308 and thecalcaneus 312. The interconnection of the respective honey portions ofthe foot 300 may be provided to augment or replace the spring ligamentof the foot 300. The spring ligament to the foot 300 may be furtheraugmented by interconnecting the respective construct, such as theconstruct 20 or the construct 170, with the spring ligament. Theinterconnection of the construct relative to the spring ligament may beprovided by further suturing the construct to the spring ligament. Forexample, the construct may be sutured directly to the spring ligament bygenerally known suture techniques such as threading or knotting theappropriate construct to a portion of the spring ligament that isremaining in the foot 300. For example, the spring ligament may beinterconnected by the navicular bone 308 portion and the augment may besutured to the spring ligament that remains connected at the boneportion. Accordingly, it is understood that the construct, as discussedabove, may be provided to replace or augment the spring ligament in thefoot 300. Moreover, the construct may be interconnected with arespective bone portion of the foot 300, according to variousembodiments, including those discussed above. The construct, such as theconstruct 20, the construct 100, or the construct 170 may be formedthrough various weaving and molding techniques to provide an appropriateconstruct to replace or augment the spring ligament in the foot 300.

With reference to FIGS. 9 and 10, a deltoid ligament in the foot 300 caninterconnect a tibia 321 relative to the foot 300. The deltoid ligamentcan interconnect the tibia 320 relative to the calcaneus 312, thenavicular 308, and a talus 322. The tibia 321, the talus 322, thenavicular 308 and the calcaneus 312 can be interconnected with aconstruct 350, as illustrated in FIG. 9. The ligament construct 350 caninclude construct bodies 350 a and 350 b that are formed similar to theligament construct 20, as discussed above. Accordingly, the constructbodies 350 a and 350 b can be formed as substantially elongated membersextending between first and second respective ends and can be formed ofa woven polymer material and/or a solid material.

According to various embodiments, the first construct body 350 a canextend from a first end 360 that has a first eyelet formed by foldingover and fixing (e.g. via suturing or sonically welding) with a fixingmember or system 362 a terminal end of the main body to an internalposition of the body 350 a. Positioned through the eyelet at the firstend 360 can be a first suture construct 364. The first suture construct364 can be similar to the suture construct 50 discussed above, and willnot be described here in detail. Nevertheless, the suture construct 364can include a collapsible tube 366 that is formed around a suture 368that passes through a passage portion 370 with first and second sutureends 372 and 374 extending therefrom. As discussed above, the sutureconstruct 364 can be positioned relative to a bone portion, as discussedfurther herein, to allow the collapsible tube 366 to form an anchoringmass by drawing or pulling on the suture end 372 and 374.

The first construct body 350 a may extend from the first end 360 to asecond end 380 that also has an eyelet that may be formed by fixing aterminal end at the second end 380 with a fixation portion 382. A secondsuture construct 390 can also be passed through the eyelet that includesa collapsible tube 394 formed around a suture 396. The suture 396 canhave a passage portion 398 through which the suture passes and a firstend 400 and a second end 402 extends therefrom. Again, the sutureconstruct 390 can be used to tension and anchor the first body 350 arelative to selected boney portions, as discussed further herein.

Additionally, passed or formed through the eyelet at the second end 380can be the second construct body 350 b. The second construct body 350 bcan extend from a first end 420 that forms an eyelet by having aterminal end portion fixed a distance from the terminal end with afixation mechanism 422. Passed through the eyelet formed at the firstend 420 can be a third suture construct 430, similar to the sutureconstructs 364 and 390. Accordingly, the suture construct 430 caninclude a collapsible tube 432 that is formed around a suture 434 thatpasses through a passage body or portion 436 with a first terminal end438 and a second terminal end 440 extending therefrom. Again, the sutureconstruct 430 can be used to fix or anchor the second body portion 350 bby forming the collapsible tube 432 into an anchor mass by pulling onthe terminal suture ends 438 and 440.

The second construct body 350 b may extend from the first end 420 to asecond end 450 that may also include a second eyelet formed by fixing aterminal end a distance from the terminal end with a fixation portion452. A fourth suture construct 460 can also be passed through the eyeletformed at the second end 450. The fourth suture construct 460 caninclude a collapsible tube 462 that is formed over a suture 464. Thesuture 464 can include a passage portion 466 from which extends a firstterminal suture end 468 and a second terminal suture end 470. Therefore,the fourth suture construct 460 can also be used to form an anchoringmass by drawing the terminal suture ends 468 and 470 as discussed above.

The augment or replacement construct 350 can be used to interconnect atleast a tibia 321, talus 322, navicular 308, and calcaneus 312 bypositioning the respective suture constructs, 390, 430, 460, and 364 inbone tunnels formed in the respective bone portions. Without repeatingthe procedure discussed above for forming the bone tunnels, bone tunnelscan be formed in and/or through each of the bone portions similar to amanner as discussed above. Accordingly, a first tunnel 500 can be formedin the tibia 321 and the collapsible tube 394 can be formed into theanchoring mass 394′ on an exterior surface of the tibia 321. A portionof the construct 350 can then be tensioned or drawn into the tunnel 500,as discussed above. A second tunnel 520 can be formed through the talus322 and the collapsible tube 432 can be formed into the anchoring mass432′ on an exterior surface of the talus 322. A portion of the construct350 can be tensioned into the tunnel 520, as discussed above. A thirdtunnel 530 can be formed in the calcaneus 312 and an anchor mass 366′can be formed from the collapsible tube 366 and the construct can betensioned into or onto the calcaneus 312, as discussed above.

A fourth tunnel 540 can be formed into the interior talus or,alternatively, into the navicular 308 (shown in phantom at 540′). It isunderstood, however, that if the alternative tunnel 540′ is formed inthe navicular 308 the tunnel 540 may also be formed in an anteriorportion of the talus 322 to allow connection of the navicular 308 andthe talus 322. The suture construct can be similar to the anchor 120,illustrated in FIG. 2B, to allow for interconnection with a tunnelformed in the anterior portion of the talus 322. Accordingly, it isunderstood that the construct 350 can be provided to interconnect aplurality of bone portions of the foot 300 including interconnectionwith a leg bone portion, such as the tibia 321. Moreover, it isunderstood that the suture constructs can be provided in variousconfigurations to allow for fixing of the ligament or tendon construct350 to the respective bone portions.

It is understood that the various embodiments of the ligament constructsincluding the eyelets discussed above can be formed in substantiallysimilar manner and interchanged for various purposes. Moreover, aselected eyelet can be formed in an appropriate manner for selectedprocedures, as is understood by one skilled in the art. Moreover,forming the eyelets in various manners can be used for productions,efficiencies and/or costs and specific procedures.

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure. Individual elements or featuresof a particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and may be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the disclosure, and all such modificationsare intended to be included within the scope of the disclosure. Theterminology used herein is for the purpose of describing particularexample embodiments only and is not intended to be limiting. As usedherein, the singular forms “a,” “an,” and “the” may be intended toinclude the plural forms as well, unless the context clearly indicatesotherwise.

What is claimed is:
 1. A method of replacing or augmenting a naturalspring ligament connecting a first bone and a second bone of a foot witha construct having a first anchor assembly and a second anchor assembly,comprising: passing the first suture assembly into a first bore holeformed in the first bone; inserting a first fixation member into thefirst bore hole with the first suture assembly to fix the first sutureanchor assembly within the first bore hole; passing the second sutureassembly into a second bore hole formed in the second bone; andinserting a second fixation member into the second bore hole with thesecond suture assembly to fix the second suture anchor assembly withinthe second bore hole; wherein the insertion of at least one of the firstand second fixation member tensions the corresponding first or secondsuture anchor assembly to selectively tension the construct between thefirst and second bones.
 2. The method of claim 1, wherein forming thefirst bore hole, further comprises: boring the first hone such that thefirst bore hole comprises a small bore portion; and boring the firstbone such that the first bore hole comprises a large bore portion;wherein the large bore portion has a greater diameter than the smallbore portion.
 3. The method of claim 2, wherein forming the second borehole, further comprises: boring the second bone such that the secondbore hole comprises a small bore portion; and boring the second bonesuch that the second bore hole comprises a large bore portion; whereinthe large bore portion has a greater diameter than the small boreportion.
 4. The method of claim 3, wherein the small bore portions ofthe first and second bore hole have a diameter of about 2 mm to about 4mm; wherein the small bore portions of the first and second bore holehave a diameter of about 4 mm to about 6 mm.
 5. The method of claim 3,wherein at least a portion of the construct is received in the largebore portion in at least one of the first bore hole and the second borehole.
 6. The method of claim 1, wherein the first and second bore holesare formed by a process comprising: boring a pilot hole with a smallerouter diameter drill hit; and expanding the pilot hole with a largerouter diameter drill bit.
 7. The method of claim 6, wherein the largerouter diameter is cannulated to pass over the smaller outer diameterdrill bit such that the smaller outer diameter drill bit guides thelarger outer diameter into engagement with the first and second boreholes.
 8. The method of claim 6, wherein the pilot hole is boredentirely through at least one of the first and second bone such that theresulting first or second bore hole is a tunnel extending entirelythrough the corresponding first and second hone with an opening at bothends of the tunnel.
 9. The method of claim 1, wherein the first bone isthe navicular bone and the second bone is calcaneus bone.
 10. The methodof claim 1, wherein the construct is passed beneath a portion of thefirst and second bones when tensioned between the first and secondbones.
 11. The method of claim 1, further comprising: inserting at leasta portion of the construct into at least one of the first bore hole andthe second bore hole to shorten the effective length construct totension the construct.
 12. The method of claim 1, wherein the constructcomprises a woven or braided material.
 13. The method of claim 1,wherein the first and second fixation members comprise interferencescrews.
 14. The method of claim 1, wherein the construct has a planarshape having a width.
 15. The method of claim 14, wherein the first andsecond suture anchor assemblies have a diameter less than the width ofthe planar shape.
 16. The method of claim 1, wherein at least one of thefirst and second suture anchor assemblies further comprises: at leastone suture terminal end insertable into the corresponding first orsecond bore holes to form an anchoring mass.
 17. The method of claim 16,wherein the at least one suture terminal end is operably engaged to atleast one of the first and second fixation members prior to insertion ofthe first and second fixation members into the corresponding first orsecond bore holes.